Multidisciplinary Perspectives in Giant Cell Arteritis: A Team-based Approach for Improved Quality of Care

Issue: March 2019

Giant cell arteritis (GCA) is the most common form of medium- and large-vessel vasculitis. If left untreated, patients with GCA are at increased risk for a range of short- and long-term complications. Diagnosis of GCA remains difficult due to the non-specific nature of many early symptoms. Until recently, therapeutic options were limited to prolonged, high-dose glucocorticoid therapy, which has the potential for many undesirable side effects. In this CME activity, expert faculty will discuss the clinical and immunopathologic features of GCA, current therapeutic options, as well as data for new and emerging agents. Strategies for how to adopt a multidisciplinary approach for the care of patients with GCA will be discussed.

Pretest

1. A 73-year-old woman presents to your clinic with a new-onset headache with scalp tenderness, abrupt onset of visual disturbances, jaw claudication, and unexplained fever, and your clinical suspicion is a diagnosis of giant cell arteritis (GCA). Which of the following is true regarding visual disturbances, as seen in this patient, in GCA?

A. Visual loss (VL) is present in two-thirds of patients with GCA.

B. Established VL is reversible.

C. Visual symptoms in suspected GCA is a medical emergency.

D. 80% of VL in GCA is due to central retinal artery occlusion.

2. Which of the following is true regarding treatment with tocilizumab for GCA?

A. It is approved for initial monotherapy.

B. It should be given in combination with a tapering course of glucocorticoids.

C. In clinical trials, more serious adverse events were seen in tocilizumab-treated patients than in steroid-only groups.

D. The optimal dose is 162 mg intravenous (IV) every 2 weeks.

3. Based on the results of the GiACTA trial, when is it appropriate to use the IL-6 inhibitor, tocilizumab, in patients with GCA?

A. As monotherapy, immediately, to prevent visual loss.

B. As monotherapy, immediately, to improve all GCA-related symptoms.

C. In combination with prednisone, to achieve greater sustained remission than with prednisone monotherapy.

D. For relapse only, to improve all GCA-related symptoms.

4. Which of the providers listed below would NOT typically encounter patients with GCA?

A. Ophthalmologists.

B. Rheumatologists.

C. Emergency Medicine/Urgent Care Specialists.

D. Pediatricians.

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Learning Objectives:

Upon completion of this educational activity, participants should be better able to:

Apply knowledge of appropriate medical work-up and diagnostic tools to the recognition of patients with GCA and refer to a specialist as necessary.
Assess the long-term benefit of IL-6 inhibitors for GCA management in terms of safety, efficacy, and patient-reported outcomes.
Implement evidence-based glucocorticoid-sparing treatment strategies for patients with GCA.

Adopt a multidisciplinary approach for the care of patients with GCA.

Overview:

Author(s)/Faculty: Leonard H. Calabrese, DO; Michael S. Lee, MD; Sebastian H. Unizony, MD

Source: Healio Rheumatology Education Lab

Type: Monograph

Articles/Items: 6

Release Date: 12/1/2018

Expiration Date: 12/1/2019

Credit Type: CME

Number of Credits: 1.25

Cost: Free

Provider: Vindico Medical Education

CME Information

Provider Statement: This continuing medical education activity is provided by Vindico Medical Education.

Support Statement: This continuing medical education activity is provided by Vindico Medical Education.

Target Audience: The intended audience for this activity is rheumatologists and other health care professionals involved in the treatment of patients with rheumatoid arthritis (RA) and other chronic inflammatory conditions.